Provider Demographics
NPI:1164506630
Name:WICKLIFFE ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:WICKLIFFE ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-434-5559
Mailing Address - Street 1:11176 E 470
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-2655
Mailing Address - Country:US
Mailing Address - Phone:918-434-5559
Mailing Address - Fax:918-434-5515
Practice Address - Street 1:11176 E 470
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-2655
Practice Address - Country:US
Practice Address - Phone:918-434-5559
Practice Address - Fax:918-434-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare